Director of Medical Economics

This is a fully remote position, open to applicants in United States.

📋 Description

• Take charge of total cost-of-care analytics across all payer contracts, encompassing PMPM, utilization, and service grouper categories utilizing Tuva infrastructure.

• Formulate calculations for shared savings, develop baseline and trend constructs, and create approaches for member mix and service mix adjustments.

• Convert the effectiveness of the clinical model into actionable outputs that enhance the care model and demonstrate program value for plan partners.

• Oversee reporting in collaboration with payer partners and act as Daymark's analytical liaison to the plan medical economics and actuarial teams.

• Construct and manage both internal and external reporting infrastructure, which includes payer-facing savings dashboards and internal trend and utilization reports.

• Work alongside Product and Engineering teams to develop data models and agentic workflows.

• Spearhead Daymark's medical economics AI strategy and pinpoint high-value LLM and agentic workflow use cases.

• Establish AI tooling infrastructure and agentic EHR monitoring workflows to facilitate proactive care pathway identification.

• Assist in claims-based opportunity assessments for prospective payer collaborations.

• Represent Daymark's analytical perspective during payer negotiations.

• Partner with the actuary and finance team on modeling, trending, and conducting actuarial reviews.

⛳️ Requirements

• Proven experience in total cost-of-care analytics across various payer contracts.

• Proficiency with PMPM, utilization, and service grouper categories.

• Demonstrated experience in developing shared savings calculations, baselines, trends, and adjustments for member/service mix.

• Background in payer reporting and collaboration with medical economics and actuarial teams.

• Experience in constructing reporting stacks and savings dashboards.

• Familiarity with collaborating with Product and Engineering on data models and agentic workflows.

• Knowledge of LLMs, AI strategies, claims analytics, and reporting automation.

• Experience in building AI tooling infrastructure and agentic EHR monitoring workflows.

• Competence in executing claims-based opportunity assessments, cost and utilization benchmarking, and identifying savings levers.

• Capability to defend savings estimates, attribution methodologies, and contract terms during payer negotiations.

• Ability to function as a hands-on individual contributor within a lean, rapidly growing organization.

🏝️ Benefits

• Comprehensive health insurance package.

• Flexible working hours and remote work options.

• Opportunities for professional development and growth.

• Collaborative and innovative work environment.

• Competitive salary and performance-based incentives.